Bottom Line:
The use of tacks and transfascial sutures is commonplace.These did not appear to be recurrent hernias as definite findings of fascial defects were present related to the tack sites themselves.More research and possibly other fixation devices may prevent this entity from becoming more prevalent.

Affiliation: Department of Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana, USA.

ABSTRACTThe repair of incisional and ventral hernias by the laparoscopic method is finding its place in the general surgical field. The use of tacks and transfascial sutures is commonplace. A new hernia has been identified. Two hernias have been seen following the successful repair of incisional hernias. These did not appear to be recurrent hernias as definite findings of fascial defects were present related to the tack sites themselves. This raises the question that possibilities exist that more of these "tack" hernias may be identified in the future. More research and possibly other fixation devices may prevent this entity from becoming more prevalent.

Figure 2: Laparoscopic appearance of the side opposite of the presenting hernia. The fascial defects at the site of the tacks are easily apparent.

Mentions:
At laparoscopy, it was found that a neomesothelium covered the visceral surface of the prosthetic biomaterial. A few omental adhesions were adherent to this membrane. This surface covering was entered to easily expose the patch. At the site of the hernia, several tacks were not secure within the hernia defect itself. This was clearly between two of the transfascial sutures. The transfascial sutures were intact and were not involved as part of the defect (Figure 1). Additionally, inspection of the contralateral side of the prosthetic biomaterial revealed fascial defects that were adjacent to tacks. These are felt to represent small hernias (Figure 2).

Figure 2: Laparoscopic appearance of the side opposite of the presenting hernia. The fascial defects at the site of the tacks are easily apparent.

Mentions:
At laparoscopy, it was found that a neomesothelium covered the visceral surface of the prosthetic biomaterial. A few omental adhesions were adherent to this membrane. This surface covering was entered to easily expose the patch. At the site of the hernia, several tacks were not secure within the hernia defect itself. This was clearly between two of the transfascial sutures. The transfascial sutures were intact and were not involved as part of the defect (Figure 1). Additionally, inspection of the contralateral side of the prosthetic biomaterial revealed fascial defects that were adjacent to tacks. These are felt to represent small hernias (Figure 2).

Bottom Line:
The use of tacks and transfascial sutures is commonplace.These did not appear to be recurrent hernias as definite findings of fascial defects were present related to the tack sites themselves.More research and possibly other fixation devices may prevent this entity from becoming more prevalent.

Affiliation:
Department of Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana, USA.

ABSTRACTThe repair of incisional and ventral hernias by the laparoscopic method is finding its place in the general surgical field. The use of tacks and transfascial sutures is commonplace. A new hernia has been identified. Two hernias have been seen following the successful repair of incisional hernias. These did not appear to be recurrent hernias as definite findings of fascial defects were present related to the tack sites themselves. This raises the question that possibilities exist that more of these "tack" hernias may be identified in the future. More research and possibly other fixation devices may prevent this entity from becoming more prevalent.